Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease: a multicenter cross-sectional study

LI Xue; YU Xinyuan; ZHU Jiao; HAO Na; LI Xia; DONG Anmin; MA Youjia

doi:10.16016/j.2097-0927.202604084

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Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease: a multicenter cross-sectional study

Monographic Reports | 更新时间：2026-07-15

- Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease: a multicenter cross-sectional study
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1827-1836(2026)
- 作者机构：
  
  1.重庆医科大学附属第二医院消化内科，重庆
  2.西安交通大学第一附属医院消化内科，陕西西安
  3.郑州大学第二附属医院消化内科，河南郑州
- 作者简介：
  
  MA Youjia， E-mail：302921@hospital.cqmu.edu.cn
- 基金信息：
  
  the Scientific Research Project for Nursing Backbone Talents of the Second Affiliated Hospital of Chongqing Medical University(HL2024-14)
- DOI：10.16016/j.2097-0927.202604084
  CLC： R395.6;R492;R735.35
- Received：24 April 2026，
  
  Revised：2026-06-06，
  
  Accepted：07 June 2026，
  
  Published：15 July 2026
- 稿件说明：
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李雪，余鑫源，朱姣，等.患者焦虑抑郁、配偶的照顾负担和心理应激影响中青年炎症性肠病患者配偶婚姻调适度：一项多中心横断面研究［J］.陆军军医大学学报，2026，48（13）：1827-1836.DOI：10.16016/j.2097-0927.202604084.

LI X，YU X Y，ZHU J，et al.Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease： a multicenter cross-sectional study［J］.J Army Med Univ，2026，48（13）：1827-1836.DOI：10.16016/j.2097-0927.202604084.
李雪，余鑫源，朱姣，等.患者焦虑抑郁、配偶的照顾负担和心理应激影响中青年炎症性肠病患者配偶婚姻调适度：一项多中心横断面研究［J］.陆军军医大学学报，2026，48（13）：1827-1836.DOI：10.16016/j.2097-0927.202604084. DOI：

LI X，YU X Y，ZHU J，et al.Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease： a multicenter cross-sectional study［J］.J Army Med Univ，2026，48（13）：1827-1836.DOI：10.16016/j.2097-0927.202604084. DOI：

摘要

目的

炎症性肠病（inflammatory bowel disease，IBD）病程迁延、症状反复，患者长期疾病压力不仅影响自身心理状态，也可能通过夫妻互动和照护情境影响配偶的婚姻调适。本研究基于患者-配偶二元视角，了解中青年IBD患者配偶婚姻调适度现状，分析患者焦虑抑郁、配偶照顾负担及配偶心理应激反应与配偶婚姻调适度之间的关系，以期为IBD患者家庭支持和夫妻共同应对干预提供参考。

方法

采用多中心横断面研究设计方案，于2025年3—7月便利抽取，共纳入123对在重庆、西安、郑州3所三级甲等医院消化内科住院部就诊的中青年IBD患者及其配偶作为研究对象。采用一般资料调查表、医院焦虑抑郁量表（hospital anxiety and depression scale，HADS）、婚姻调适度量表（marital adjustment test，MAT）、照顾者负担量表（Zarit burden interview，ZBI）和应激反应问卷（stress response questionnaire，SRQ）进行调查。主要变量间相关性采用Spearman相关分析；以配偶MAT总分为因变量，采用分层多元线性回归分析配偶婚姻调适度的相关因素，并以SRQ总分替代ZBI总分进行敏感性分析。

结果

患者HADS总分为11.00（8.00，16.00）分，配偶HADS总分为9.00（6.00，15.00）分，患者HADS总分高于配偶（

=-3.45，

=0.001）。配偶ZBI总分为16.00（10.00，23.00）分，SRQ总分为37.00（32.00，47.00）分；SRQ情绪反应因子、躯体反应因子和行为反应因子得分分别为16.00（13.00，20.00）分、12.00（10.00，15.00）分和7.00（6.00，9.00）分。Spearman相关分析显示，配偶MAT总分与患者HADS总分（

rₛ

=-0.50）、配偶HADS总分（

=-0.45）、配偶ZBI总分（

=-0.56）及配偶SRQ总分（

rₛ

=-0.56）均呈负相关（

均0.01）；患者HADS总分与配偶HADS总分呈正相关（

rₛ

=0.62，

0.01）；配偶ZBI总分与配偶SRQ总分呈正相关（

rₛ

=0.77，

0.01）。分层多元线性回归分析显示，模型1纳入配偶年龄、配偶文化程度和疾病严重程度后，可解释配偶婚姻调适度变异的15%（

R²

=0.15，调整

R²

=0.13，

0.001）；模型2进一步加入患者HADS总分、配偶HADS总分和配偶ZBI总分后，模型解释度提高至62%（

R²

=0.62，调整

R²

=0.60，

ΔR²

=0.47，

=47.53，

0.001）。模型2结果显示，配偶年龄（

=3.64，95%

：1.01~6.28，

=0.20，

=0.01）、配偶文化程度（

=6.31，95%

：1.04~11.58，

=0.16，

=0.02）、患者HADS总分（

=-0.80，95%

：-1.39~-0.21，

=-0.23，

=0.01）和配偶ZBI总分（

=-0.75，95%

：-0.99~-0.51，

=-0.52，

0.001）与配偶MAT总分相关。共线性诊断显示，模型2各变量方差膨胀因子（variance inflation factor，VIF）均5。敏感性分析显示，以SRQ总分替代ZBI总分后，SRQ总分仍与配偶MAT总分呈负相关（

=-0.70，95%

：-0.93~-0.46，

=-0.56，

0.001）。

结论

中青年IBD患者配偶婚姻调适度较低。患者焦虑抑郁水平、配偶照顾负担及配偶心理应激反应均与配偶婚姻调适度降低相关。临床护理人员应从患者-配偶二元视角出发，关注IBD患者及配偶心理状态，开展面向夫妻双方的疾病教育、心理支持、照护技能指导和二元应对干预。

Abstract

Objective

Inflammatory bowel disease(IBD) is characterized by a protracted course and recurrent symptoms

and the long-term disease-related stress on patients not only impairs their own psychological status

but may also affect their spouses’ marital adjustment through marital interaction and caregiving processes. Based on a patient-spouse dyadic perspective

this study aims to investigate the current status of marital adjustment among spouses of young and middle-aged patients with IBD

and to analyze the relationships of patient anxiety and depression

and spouse caregiving burden and psychological stress with spousal marital adjustment

with the goal of providing a reference for family support and couple-based coping interventions for IBD patients.

Methods

A multicenter cross-sectional study design was adopted. From March to July 2025

a total of 123 pairs of middle-aged and young IBD adults and their spouses who were admitted to the gastroenterology departments of 3 tertiary grade A hospitals in Chongqing

Xi’an

and Zhengzhou were recruited with convenience sampling. The participants were investigated using general information questionnaires

Hospital Anxiety and Depression Scale(HADS)

Marital Adjustment Test(MAT)

Zarit Burden Interview(ZBI)

and Stress Response Questionnaire(SRQ). Spearman correlation analysis was adopted to examine the correlations among the main variables. Hierarchical multiple linear regression was performed with the total MAT score of the spouse as the dependent variable to identify the factors associated with spousal marital adjustment

and a sensitivity analysis was conducted by replacing the total ZBI score with the total SRQ score.

Results

The total HADS score was 11.00(8.00

16.00) for patients and 9.00(6.00

15.00) for spouses

indicating significantly higher anxiety and depression levels in the patients than the spouses(

=-3.45

=0.001). For the spouses

the total ZBI score was 16.00(10.00

23.00)

and the total SRQ score was 37.00(32.00

47.00)

and the scores of emotional response

physical response

and behavioral response subscales of SRQ were 16.00(13.00

20.00)

12.00(10.00

15.00) and 7.00(6.00

9.00)

respectively. Spearman correlation analysis showed that the total MAT score of spouses was negatively correlated with patients’ total HADS score(

rₛ

=-0.50)

and spouses’ total HADS score(

rₛ

=-0.45)

total ZBI score(

rₛ

=-0.56) and total SRQ score(

rₛ

=-0.56)(all

0.01); the patients’ total HADS score was positively correlated with spouses’ total HADS score(

rₛ

=0.62

0.01); and spouses’ total ZBI score was positively correlated with their own total SRQ score(

rₛ

=0.77

0.01). Hierarchical multiple linear regression analysis showed that Model 1

after adjusting for spouses’ age and education level and disease severity

explained 15.0% of the variance in spousal marital adjustment(

R²

=0.15

adjusted

R²

=0.13

0.001). After further incorporating patients’ total HADS score

and spouses’ total HADS score and total ZBI score into Model 2

the explanatory power was markedly increased to 62%(

R²

=0.62

adjusted

R²

=0.60

ΔR

²=0.47

=47.53

0.001). The results of Model 2 demonstrated that spouses’ age(

=3.64

95%

: 1.01 to 6.28

=0.20

0.01)

education level(

=6.31

95%

: 1.04 to 11.58

=0.16

=0.02)

and total ZBI score(

=-0.75

95%

: -0.99 to -0.51

=-0.52

0.001)

and patients’ total HADS score(

=-0.80

95%

: -1.39 to -0.21

=-0.23

0.01) were significantly associated with the total MAT score of spouses. Collinearity diagnostics presented that the variance inflation factor(VIF) of each variable in Model 2 was 5. Sensitivity analysis indicated that the total SRQ score remained negatively associated with the total MAT score of spouses after replacing the total ZBI score with the total SRQ score(

=-0.70

95%

: -0.93 to -0.46

=-0.56

0.001).

Conclusion

The spouses of young and middle-aged IBD patients have relatively poor marital adjustment. Patients’ anxiety and depression levels

as well as spouses’ caregiving burden and psychological stress

are all associated with decreased spousal marital adjustment. Clinical nurses should adopt a patient-spouse dyadic perspective

pay close attention to the psychological states of IBD patients and their spouses

and implement targeted interventions including disease education

psychological support

caregiving skill training and dyadic coping interventions for both spouses.

关键词

Keywords

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